Tn: Psychiatry - 1

Front 1

Epidemiology of suicide?

Back 1

Ratio of attempted to completed suicide is 20:1

Front 2

Do more males of females attempt suicide?

Back 2

Females (M:F ratio is 1:4)

Front 3

Do more males or females complete suicide?

Back 3

Males (M:F ratio is 3:1)

Front 4

What is the acronym to remember the suicide risk factors?

Back 4

SAD PERSONS

Front 5

List the risk factors for suicide (remember the acronym!)

Back 5

S = sex

A = age (>60 yr)

D = depression

P = previous attempts

E = ethanol abuse

R = rational thinking loss (delusions, hallucinations, hopelessness)

S = suicide in the family

O = organized plan

N = no spouse (no support systems)

S = serious illness, intractable pain

Front 6

T/F: suicide is the second most common cause of death for ages 15-24?

Back 6

True

Front 7

Which races have high suicide risk?

Back 7

White or native Canadians on reserves

Front 8

Lifetime risk of suicide in depression?

Back 8

15% (even higher in Bipolar disease)

Front 9

Lifetime risk of suicide in patients with schisophrenia?

Back 9

10-15%

Front 10

Lifetime risk of suicide if concomittant substance abuse disorder?

Back 10

15% lifetime risk

Front 11

Lifetime risk of suicide if patient has an eating disorder?

Back 11

5%

Front 12

What about a patients past history may increase their risk of suicide?

Back 12

Prior suicide attempt

Fmaily history of suicide attempt/completion

Front 13

What clinical symptoms are associated with suicide? (7)

Back 13

1. Hopelessness
   
2. Anhedonia
   
3. Insomnia
   
4. Severe anxiety
   
5. Impaired concentration
   
6. Psychomotor agitation
   
7. Panic attacks
   

SHAPPII

Front 14

Defined passive ideation

Back 14

Would rather not be alive but has no active plan for suicide

Front 15

Define active ideation

Back 15

Thinking about killings onself

Front 16

How to ask about a plan?

Back 16

"Do you have a plan as to how you would end your life?"

Front 17

How to ask about intent?

Back 17

"You talk about not wanting to die, but are you planning to do this? or "What has stopped you from ending your life?"

Front 18

How to ask about past attempts of suicide?

Back 18

Highest risk if previous attempt in past year

Ask about:

• lethality
  
• outcome
  
• medical interventions
  

Front 19

Components of a suicide ideation assessment?

Back 19

• onset and frequency of thoughts
  
• control over suicidal ideation
  
• lethality
  
• access to means
  
• time and place
  
• provocative factors
  
• protective factors
  
• final arrangments
  
• practiced suicide or aborted attempts
  

ambivalence

Front 20

How to assess suicide attempt?

Back 20

• setting
  
• planned
  
• intoxication
  
• medical attention
  
• time lag from suicide attempt to ER arrival
  
• expectation of lethality, dying
  
• reaction to survival
  

Front 21

How to manage high risk of suicide?

Back 21

Hospitalization needs to be strongly considered

So, if patient has:

plan

access

recent social stressors

symptoms suggest of psych disorder

Front 22

What to do if patient refuses to be hospitalized?

Back 22

Complete form for involuntary admission

Front 23

How to manage lower risk patients?

Back 23

Patients who are not actively suicidal, with no plan or access to lethal means should make a safety plan

Front 24

What is a safety plan?

Back 24

Agreement they will:

• not harm themselves
  
• avoid alcohol, drugs, and situations that may trigger suicidal thoughts
  
• Follow up with you at a designated time
  
• contact a health care worker if they feel unsafe
  

Front 25

How to manage patient with depression/suicide?

Back 25

consider hospitalization if symptoms severe or if psychotic features present, otherwise outpatient treatment with good supports and SSRIs/SNRIs

Front 26

How to manage alcohol-related/suicide?

Back 26

Usually resolves with abstinence for a few days; if not, suspect depression

Front 27

How to manage personality disorders/suicide?

Back 27

Crisis intervention/confrontation

May or may not hospitalize

Front 28

How to manage shizophrenia/psychosis/suicide?

Back 28

Hospitalization might be necessary

Front 29

How to manage parasuicide/self-mutalation?

Back 29

Long-term psychotherapy with brief crisis intervention when necessary